Clinical Nutrition and Enteral Feeding

Enteral nutrition delivers formula through a tube into the stomach or small intestine when oral intake is unsafe or insufficient and the gastrointestinal tract can still be used. Common routes include nasogastric, gastrostomy, and jejunostomy tubes. Using the gut is generally preferable to abandoning it, but tube feeding is not simply “food through a line.” The route affects airway safety, gastrointestinal function, medication administration, fluid balance, and the timing of escalation. Aspiration is the most time-sensitive hazard. Formula can enter the airway when the tube is misplaced, gastric contents reflux, or the patient has impaired consciousness, swallowing, cough, or gastric emptying. Abdominal distention, pain, nausea, vomiting, and diarrhea may indicate that the prescribed delivery is not being tolerated. A change in the patient often matters more than a number from the feeding pump. Enteral feeding should not be initiated in the presence of: - intestinal obstruction; - a high-output gastrointestinal fistula; - uncontrolled gastrointestinal bleeding; or - hemodynamic instability that remains unresponsive to fluid resuscitation and vasopressors. These findings suggest that gastrointestinal transit, tissue integrity, or organ perfusion is too...